Tags

Type your tag names separated by a space and hit enter

One hundred and twelve infected arthroplasties treated with 'DAIR' (debridement, antibiotics and implant retention): antibiotic duration and outcome.
J Antimicrob Chemother 2009; 63(6):1264-71JA

Abstract

OBJECTIVES

We describe treatment failure rates by antibiotic duration for prosthetic joint infection (PJI) managed with debridement, antibiotics and implant retention (DAIR).

METHODS

We retrospectively collected data from all the cases of PJI that were managed with DAIR over a 5 year period. Surgical debridement, microbiological sampling, early intravenous antibiotics and prolonged oral follow-on antibiotics were used.

RESULTS

One hundred and twelve cases of PJI were identified. Twenty infections (18%) recurred during a mean follow-up of 2.3 years. The mean duration of antibiotic use was 1.5 years. Failure was more common after arthroscopic debridement, for previously revised joints and for Staphylococcus aureus infection. There were 12 failures after stopping antibiotics and 8 while on antibiotics [hazard ratio (HR) = 4.3, 95% confidence interval (CI) 1.4-12.8, P = 0.01]. However, during the first 3 months of follow-up, there were eight failures after stopping antibiotics and two while on antibiotics (HR = 7.0, 95% CI 1.5-33, P = 0.015). The duration of antibiotic therapy prior to stopping did not predict outcome.

CONCLUSIONS

PJI may be managed by DAIR. The risk of failure with this strategy rises after stopping oral antibiotics, but lengthening antibiotic therapy may simply postpone, rather than prevent, failure.

Authors+Show Affiliations

Nuffield Orthopaedic Centre, Oxford, UK. ivor.byren@orh.nhs.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19336454

Citation

Byren, I, et al. "One Hundred and Twelve Infected Arthroplasties Treated With 'DAIR' (debridement, Antibiotics and Implant Retention): Antibiotic Duration and Outcome." The Journal of Antimicrobial Chemotherapy, vol. 63, no. 6, 2009, pp. 1264-71.
Byren I, Bejon P, Atkins BL, et al. One hundred and twelve infected arthroplasties treated with 'DAIR' (debridement, antibiotics and implant retention): antibiotic duration and outcome. J Antimicrob Chemother. 2009;63(6):1264-71.
Byren, I., Bejon, P., Atkins, B. L., Angus, B., Masters, S., McLardy-Smith, P., ... Berendt, A. (2009). One hundred and twelve infected arthroplasties treated with 'DAIR' (debridement, antibiotics and implant retention): antibiotic duration and outcome. The Journal of Antimicrobial Chemotherapy, 63(6), pp. 1264-71. doi:10.1093/jac/dkp107.
Byren I, et al. One Hundred and Twelve Infected Arthroplasties Treated With 'DAIR' (debridement, Antibiotics and Implant Retention): Antibiotic Duration and Outcome. J Antimicrob Chemother. 2009;63(6):1264-71. PubMed PMID: 19336454.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - One hundred and twelve infected arthroplasties treated with 'DAIR' (debridement, antibiotics and implant retention): antibiotic duration and outcome. AU - Byren,I, AU - Bejon,P, AU - Atkins,B L, AU - Angus,B, AU - Masters,S, AU - McLardy-Smith,P, AU - Gundle,R, AU - Berendt,A, Y1 - 2009/03/31/ PY - 2009/4/2/entrez PY - 2009/4/2/pubmed PY - 2009/7/1/medline SP - 1264 EP - 71 JF - The Journal of antimicrobial chemotherapy JO - J. Antimicrob. Chemother. VL - 63 IS - 6 N2 - OBJECTIVES: We describe treatment failure rates by antibiotic duration for prosthetic joint infection (PJI) managed with debridement, antibiotics and implant retention (DAIR). METHODS: We retrospectively collected data from all the cases of PJI that were managed with DAIR over a 5 year period. Surgical debridement, microbiological sampling, early intravenous antibiotics and prolonged oral follow-on antibiotics were used. RESULTS: One hundred and twelve cases of PJI were identified. Twenty infections (18%) recurred during a mean follow-up of 2.3 years. The mean duration of antibiotic use was 1.5 years. Failure was more common after arthroscopic debridement, for previously revised joints and for Staphylococcus aureus infection. There were 12 failures after stopping antibiotics and 8 while on antibiotics [hazard ratio (HR) = 4.3, 95% confidence interval (CI) 1.4-12.8, P = 0.01]. However, during the first 3 months of follow-up, there were eight failures after stopping antibiotics and two while on antibiotics (HR = 7.0, 95% CI 1.5-33, P = 0.015). The duration of antibiotic therapy prior to stopping did not predict outcome. CONCLUSIONS: PJI may be managed by DAIR. The risk of failure with this strategy rises after stopping oral antibiotics, but lengthening antibiotic therapy may simply postpone, rather than prevent, failure. SN - 1460-2091 UR - https://www.unboundmedicine.com/medline/citation/19336454/One_hundred_and_twelve_infected_arthroplasties_treated_with_'DAIR'__debridement_antibiotics_and_implant_retention_:_antibiotic_duration_and_outcome_ L2 - https://academic.oup.com/jac/article-lookup/doi/10.1093/jac/dkp107 DB - PRIME DP - Unbound Medicine ER -